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>> V_V�, �' �.A4 LIC ON FOR SANITATION PERMIT Permit No.�_�__�7.. t ''F Js i �` (Complete m Duplicate) "9� Date Issued / Application is hereby madeeto he San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION _��- ----------------- - �`lf - ------------------------------------------------------------------------------------------------ --- Owner's Name ----------------------------------------- ------ ---------- Phone---- Address ----------------------------------- --.._---------------- ----•- Contractor's Name "- . , ---------------------------------------------------------------- Phone------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer- Court ❑ Motel ❑ Other ❑ Number of living units: __,1'.__ Number of bedrooms ._Number of baths Lot size ________-__��_-�______-7.1___._________.__ Water Supply: Public system ❑ Community system ❑ PrivateX Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑j Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, " Hardpan ❑ p Previous Application Made: Yes ❑ No D' New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within '200 feet.) Septic T :-- Distance from nearest well_________________Distance from foundation----------_________.Material-___.___________-______________________________. No. of compartments--------------------------Size--- ---------------Liquid depfh-------------------- Capacity--.------------ Disposal Field: Distance from nearest well__ -_ Distance from foundation----_- ____Distance to nearest lot line.---___�-�'...... Number of lines.-------I------------------- Length of each line-------_--------___-_---------Width of french------------2--zt__�-- ------- Type of filter mate`rial__---�__Depth of filter material___-------__9�f____._Total length___--------------___________/-100_} Seepage Pit: Distance to nearest well----------________----Distance from foundation.----------_-__--__.Distance to nearest lot line------------_____ ❑ Number ofpits______-----•-------.--Lining material-----------------------Size:Diameter----------------__----_Depth----__---_----------------------- pv Cesspool: Distance from nearest well----_---_________Distance from foundation.---__--------------Lining material___-------____________---------______. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity....----------- ---------gals. Privy: Distance from nearest well--------_-------------------____________---------Distance from nearest building---------- ❑0 Distance to nearest lot line----------- Remodeling and/or repairing (describe) '------------=----------•---------------------- =- -------------------•-------... •-•-- ..... ------------------•---------------------------------------------------------- ... ------------------ •-------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,,/and,rules and regulations of +he San Joaquin Local Health District. (Signed) 111,fe.f -- - ----------------------------------------(Owner and/or Contractor) BY= •----•----• -------------- --------------------------- ---------------------------------(Title)-------•---------------•------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------- - - - ---- --------------------------------- --------- DATE---- REVIEWEDBY---------------------------------------------------- DATE--------------- --- -- ---- BUILDING PERMIT ISSUED------------------------------ DATE Alterations and/or recommendations:------- ------------------------------------------ -------- ------------------ ------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- AFINAL INSPECTION BY: Date.-------- SAN JOAQUIN LOCAL HEALTH-DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100